To date, outcome research suggests that providing clinicians with patient progress feedback and problem-solving tools is effective in improving therapeutic outcome for clients who are predicted to have a negative treatment outcome. To expand upon this body of research, the current study examined the efficacy of using these problem-solving tools (Clinical Support Tools; CST) to reduce the risk of treatment failure and enhance positive outcome with 118 clients who were not identified as at -risk for a negative outcome. Results of this study indicated that the intervention failed to lower the rate of becoming an at-risk case or to enhance treatment outcome. A possible explanation for the null results observed is poor treatment compliance. Based on the findings of this study, the CST cannot be recommended as an intervention across the broad range of clients who enter treatment. However, qualitative analysis results reflect positive indicators for continued research with at-risk cases.

Outcome research has documented worsening among a minority of the patient population (5 to 10%). In this study a psychotherapy quality assurance system intended to enhance outcomes in patients at risk of treatment failure was reviewed through the use of meta-analytic, mega-analytic, and multilevel analytic techniques. A pooled dataset from six major studies conducted at a large university counseling center and a hospital outpatient setting (N = 6151, mean age = 23.3 years, female = 63.2%, Caucasian = 85%) were re-analyzed to examine the effects of progress feedback on patient outcome. In this quality assurance system, the Outcome Questionnaire-45 was routinely administered to patients to monitor their therapeutic progress and was utilized as part of an early alert system to identify patients at risk of treatment failure. Patient progress feedback based on this alert system was provided to clinicians to help them intervene before treatment failure occurred. Intent-to-treat and efficacy analyses of the effects of feedback interventions were conducted to obtain the estimates of effects expected from implementation of this quality assurance system as a policy as well as in clinical trials. Three forms of feedback interventions—integral elements of this quality assurance system—were effective in enhancing treatment outcome, especially for signal alarm patients. Two of the three feedback interventions were also effective in preventing treatment failure (Clinical Support Tools and the provision of patient progress feedback to therapists). The Clinical Support Tool intervention was effective not only in terms of the amount of outcome enhancing effect, but also in the rate of patient recovery. The current state of evidence appears to support the efficacy and effectiveness of feedback interventions in enhancing treatment outcome.

Introduction Occult constipation (OC) – a subtype of constipation causing chronic or recurring gastrointestinal symptoms in the absence of classic symptoms of overt constipation – is a differential diagnosis that should be considered in patients with gastrointestinal symptoms of unclear etiology. Previous studies have investigated the symptomatology of OC and compared treatment regimens but to our knowledge there have been no studies comparing symptomatology with treatment outcomes to investigate whether some symptoms could be related to a better prognosis. Aim The aims of this study were to describe the symptoms present in patients with OC as well as investigate possible association between symptoms and treatment outcomes. Method This was a retrospective review of patient records including 88 patients under 18 years old with diagnosed constipation treated by Dr. Magnus Liljedahl at Gävle Hospital between 2017 and 2019. Results Out of the 88 patients included in the study, six (6.8 %) were classed as having suspected OC, 18 (20.5 %) confirmed OC and 44 (50.0 %) overt constipation. The most common symptoms in patients with OC were abdominal pain, fatigue, headache, back pain, and nausea. On follow-up, 16 patients with OC were symptom-free and three had symptoms remaining. When comparing symptomatology of OC with treatment outcomes no statistically significant differences were seen between the groups. Conclusion This study gives an overview of the symptoms seen in OC but limited information on any association between symptomatology and treatment outcomes. It does, however, emphasize that OC is a differential diagnosis in patients with gastrointestinal symptoms of unclear etiology.

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